Bottom Line:
Previously reported cases are also mentioned.It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present.Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.

Objective: Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. The authors present a clinical case of trichobezoar and discuss the most relevant aspects concerning this entity.

Results: Report of a 27-year-old female patient with a trichobezoar submitted to surgical removal, with a prior intervention 4 years before also due to trichobezoar, and with unknown psychiatric antecedents or follow-up.

Conclusions: A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. The discrepancies between the prevalence of trichotillomania and trichobezoars due to trichophagia may be due to issues related to self-selection of patients and symptom severity. Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.

Mentions:
A 27 year-old caucasian woman presented to the Emergency Department with bloating and weight loss for two months and recent episodes of epigastric pain, nausea and vomiting of increasing frequency and severity. Her physical examination revealed the presence of a large, hard, solid mass from epigastric to periumbilical region, mobile and painless with no other remarkable features. On further evaluation, a microcytic anemia was detected; an abdominal ultra-sound revealed a highly reflective structure not allowing in-depth evaluation, and a CT-scan reported a distended stomach, filled with heterogeneous density material, probably bezoar (Fig. 1). An upper endoscopy was eventually performed, confirming the presence of a trichobezoar occupying all gastric cavity.The patient had a previous history of a trichobezoar surgically removed in 2000, and no personal or family psychiatric history. The treatment consisted of an anterior gastrotomy with removal of bezoar and biopsy of existent gastric ulcer, which revealed the presence of human hair (Fig. 2).

Mentions:
A 27 year-old caucasian woman presented to the Emergency Department with bloating and weight loss for two months and recent episodes of epigastric pain, nausea and vomiting of increasing frequency and severity. Her physical examination revealed the presence of a large, hard, solid mass from epigastric to periumbilical region, mobile and painless with no other remarkable features. On further evaluation, a microcytic anemia was detected; an abdominal ultra-sound revealed a highly reflective structure not allowing in-depth evaluation, and a CT-scan reported a distended stomach, filled with heterogeneous density material, probably bezoar (Fig. 1). An upper endoscopy was eventually performed, confirming the presence of a trichobezoar occupying all gastric cavity.The patient had a previous history of a trichobezoar surgically removed in 2000, and no personal or family psychiatric history. The treatment consisted of an anterior gastrotomy with removal of bezoar and biopsy of existent gastric ulcer, which revealed the presence of human hair (Fig. 2).

Bottom Line:
Previously reported cases are also mentioned.It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present.Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.

Objective: Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. The authors present a clinical case of trichobezoar and discuss the most relevant aspects concerning this entity.

Results: Report of a 27-year-old female patient with a trichobezoar submitted to surgical removal, with a prior intervention 4 years before also due to trichobezoar, and with unknown psychiatric antecedents or follow-up.

Conclusions: A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. The discrepancies between the prevalence of trichotillomania and trichobezoars due to trichophagia may be due to issues related to self-selection of patients and symptom severity. Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.